| [Objectives]To analyze the advantages and disadvantages, efficacy and safety of two minimally invasive surgical methods in dealing with the pelvic calculi (1.5-3cm in diameter).To explore the the safety and clinical value of retrograde intrarenal surgery in dealing with massive pelvic calculi.[Methods]69 cases who is suffering from the pelvic calculi was chosen as sample since September 2013 to March 2015 in Urology Surgery of affiliated Qilu Hospital of Shandong University. According to medical history and preoperative imaging, all patients were respectively treated by PCNL and RIRS, after a full assessment of surgical risk and operation indication. In which 36 cases was treated by PCNL, and 33 cases was cured by RIRS. Retrospective analysis of the the efficacy and safety indicators among the two groups in the success rate on one session, the immediate stone-free rate, operative time, blood loss, complication rate, mean postoperative hospital stay, usage of painkillers and antibiotics, hospitalization expenses, etc Statistical method was applied to process the data. Quantitative data was verified for its normality by W test. If measurement data conforms to normal distribution, then use completely random designed two sample t test to compare the overall mean differences; If do not conform to the normal distribution, then use the Mann-Whitney rank test. Qualitative data between the two groups was verified by four tables Fisher exact probability test. P< 0.05 for with a statistical significance.[Results]All 69 cases were performed successfully. No statistical significance (P>0.05) was found between the two groups in sex, age, onset time, stone size, combinations, and history of ESWL treatment; The success rate on one session were both 100%; There was no significant difference between the two groups in operation time, stone-free rate after surgery, and Hospitalization expense (P> 0.05); The differences were statistically significant (P<0.05) between the two groups in post operation hospitalization duration, the surgery group of RIRS was less than the other group; The differences were statistically significant (P<0.05) between the two groups in the blood loss, the surgery group of RIRS was less than the other group; There was no significant difference between the two groups(P> 0.05) in the postoperative complication incidence, and usage of painkillers and antibiotics. Above all, RIRS is more effective and safer than PCNL.[Conclusions]1. For pelvic stones sized 1.5-3 cm in diameter, RIRS and PCNL have similar clearance rate. In terms of postoperative hospital stay and intraoperative blood loss, RIRS has obvious advantages. Also RIRS has the advantage of relatively small trauma, fewer complications and less pain. So I think it is a kind of safe and effective operation method, worthy of promotion;2. As recommended the main treatment method of massive kidney stones, PCNL has high calculi clearance rate, and the complication rate has been significantly lower than before. Although it’s not as good as RIRS in the aspects of bleeding in surgery and postoperative hospital stay, etc, with the advantage of mature operation technology and more durable equipment, PCNL still is the main surgical method of large kidney stones,especially complex kidney calculi;3. For pelvic stones 1.5-2 cm in diameter, the clearance rate were both 100%. So under the condition of no obvious operative taboo, RIRS can replace PCNL as the first-line treatment of<2cm ESWL refractory renal pelvis calculi. |
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